The Relations Of Asymptomatic Primary Hyperparathyroidism And Vertebral Fracture: A Meta-analysis And Systematic Review

BackgroundPrimary hyperparathyroidism (PHPT) is considered one of the mostcommonly diagnosed endocrine disorder. Since the introduction ofautomated measurement of serum calcium levels, the common clinicalpresentation of PHPT changed from mainly symptomatic and characterizedby fibrocystic osteitis, urinary stones, specific neuromuscular symptoms andhypercalcemic symptoms to asymptomatic at the time of diagnosis, that isasymptomatic primary hyperparathyroidism (aPHPT). It has been shownthat a variable degree of bone loss is commonly found in patients withPHPT. Considering the levels of serum calcium and PTH is slightly higherthan the normal in aPHPT, it may have a different effect on the bone,especial at the vertebral site. The vertebral fracture risk in patients withaPHPT is still a controversial issue. we undertook a meta-analysis of theeffects on lumbar spine BMD and vertebral fractures in aPHPT. ObjectiveTo investigate the effects of aPHPT on skeletal mass at vertebral bonesite and vertebral fractures.MethodsOur sources were Medline, EMBASE, and High Wire WanfangDatabase, Vip Database prior to January2014, and abstracts from meetingsof international bone and mineral societies from1987–2014.Searches werelimited to Chinese/English-language studies. Data were extracted from thetext of the retrieved articles or conference abstracts and were analyzedusing Review Manager5（RevMan5）Meta-analysis software.ResultsWe included14studies at all,it contains5retrospective studies,2prospective studies and7intervention studies. The prevalence of vertebral fractures did not differ between aPHPT patients and control in retrospective studies. The patients with aPHPT did not show significant decrease of bone mass at lumbar spine site in duration. No difference was found between before and after parathyroidectomy in patients withaPHPT in intervention studies. ConclusionIt has been shown that aPHPT is not a risk factor for vertebral fracturesand is not associated with rapid bone loss at lumbar spine site. The changesof bone mass at vertebral site to reflect the progress, prognosis andpostoperative evaluation of aPHPT disease also is not specific.